Laparoscopic management of benign adnexal mass in obese women.

STUDY OBJECTIVE

To compare complications and rate of conversion to laparotomy between normal-weight, preobese, and obese women who underwent laparoscopic management of benign adnexal mass.

DESIGN

Retrospective chart review (Canadian Task Force classification II-3).

SETTING

Tertiary care teaching hospital.

PATIENTS

One hundred seventy women who underwent laparoscopic surgery because of benign adnexal mass were placed in three groups on the basis of their body mass index (BMI) using the World Health Organization's classification (normal-weight [BMI 18.5-24.9 kg/m2], preobese [BMI 25-29.9 kg/m2], and obese [BMI > or = 30 kg/m2]).

INTERVENTION

Retrospective comparison of conversions from laparoscopy to laparotomy, operative time, estimated blood loss, complications, history of pelvic inflammatory disease, endometriosis, and length of hospital stay was carried out among the different groups.

MEASUREMENTS AND MAIN RESULTS

Overall, 170 laparoscopic cases were evaluated (64 with normal-weight, 67 preobese, and 39 obese women). The rate of conversion to laparotomy was significantly higher in the obese and preobese groups compared with the normal-weight women (17.9%, 17.9% vs 1.5%, p < .01). Obese women were 13 times more likely to undergo conversion than normal-weight women (OR 13.78; 95% CI 1.76-29.1). In addition, obese women had significantly longer surgeries (143 +/- 87 minutes vs 114 +/- 41 minutes [p = .04]) and longer hospital stay (1.07 +/- 1.83 days vs 0.51 +/- 1.06 days [p = .04]) when compared with normal-weight women. There was no significant difference in history of pelvic inflammatory disease, endometriosis, and adhesions at the time of laparoscopy between obese, preobese, and normal-weight women. The rate of complications was similar among the groups.

CONCLUSION

Obese and preobese women undergoing laparoscopic management of benign adnexal mass were found to be at an increased risk for conversion to laparotomy, longer surgery and longer hospital stay. Obese and preobese women should be counseled extensively on morbidity associated with laparoscopy.